Social Determinants of Health in Ohio

Contents of AHRQ SDOH Database

The Social Determinants of Health (SDOH) database from AHRQ compiles SDOH-related variables across multiple domains from 87 sources including multiple federal and other data sources. The downloadable files contain a total of 675 variables available by year from 2009 through 2020. Data is available across three geography levels: all 675 variables are available by county level, 319 are available by ZIP code, and 321 variables are available by census tract.

These variables are organized into five main categories containing several topics each: social context (demographics, disability, immigration, living conditions), economic context (employment, income, poverty), education (attainment), physical infrastructure (environment, housing, internet, migration, transportation), and healthcare context (characteristics of facilities, characteristics of providers, distance to provider, health insurance status, health outcomes, health care quality, utilization and costs).

(a) This map displays the total population for each county in Ohio. Darker shades of blue represent higher population totals and lighter shades represent lower population totals.

Figure 1: Ohio’s Appalachian and Non-Appalachian Counties

(a) This map displays the total population for each zip code in Athens county. Darker shades of blue represent higher population totals and lighter shades represent lower population totals.

Figure 2: Athens County Zip Codes

(a) This map displays the total population for each census tract in Athens county. Darker shades of blue represent higher population totals and lighter shades represent lower population totals.

Figure 3: Athens County Census Tracts

(a) This map displays the median household income for each county in Ohio. Darker shades of blue represent higher household incomes and lighter shades represent lower household incomes.

Figure 4: Median Household Income by County

(a) This map displays the median household income for each zip code in Ohio. Darker shades of blue represent higher household incomes and lighter shades represent lower household incomes.

Figure 5: Median Household Income by Zip Code

(a) This map displays the median household income for each zip code in Athens county. Darker shades of blue represent higher household incomes and lighter shades represent lower household incomes.

Figure 6: Athens County Median Household Income by Zip Code

(a) This map displays the median household income for each census tract in Ohio. Darker shades of blue represent higher household incomes and lighter shades represent lower household incomes.

Figure 7: Median Household Income by Census Tract

(a) This map displays the median household income for each census tract in Athens county. Darker shades of blue represent higher household incomes and lighter shades represent lower household incomes.

Figure 8: Athens County Median Household Income by Census Tract

SDOH Variables Available at the Census Tract Level

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PLACES Data

County Health Rankings Data

(a) This map displays the percent of adults with diagnosed diabetes for each county in Ohio. Darker shades of blue represent higher diabetes rates and lighter shades represent lower diabetes rates.

Figure 9: Percent of Adults with Diabetes

(a) This scatter-plot displays the relationship between median household income and diabetes rates for each Appalachian and non-Appalachian county in Ohio. The effect size of this correlation is very high (r(86) = -.83, p < .001).

Figure 10: Diabetes Rates and Median Household Incomes in Ohio’s Counties

(a) This scatter-plot displays the relationship between food insecurity and diabetes rates for each Appalachian and non-Appalachian county in Ohio. The effect size of this correlation is very high (r(86) = .87, p < .001).

Figure 11: Diabetes Rates and Food Insecurity in Ohio’s Counties

(a) This scatter-plot displays the relationship between phsyical inactivity and diabetes rates for each Appalachian and non-Appalachian county in Ohio. The effect size of this correlation is high (r(86) = .76, p < .001).

Figure 12: Diabetes Rates and Physical Inactivity in Ohio’s Counties

Figure 13: Diabetes Rates and Obesity in Ohio’s Counties

Figure 14: Diabetes Rates and Fair Health in Ohio’s Counties

Figure 15: Diabetes Rates and Poor Health in Ohio’s Counties

Figure 16: Diabetes Rates and Physical Distress in Ohio’s Counties

Figure 17: Diabetes Rates and Poor Mental Health in Ohio’s Counties

Figure 18: Diabetes Rates and Mental Distress in Ohio’s Counties

Figure 19: Diabetes Rates and Poverty in Ohio’s Counties

Figure 20: Diabetes Rates and Poverty Ratio Under 1 in Ohio’s Counties

Figure 21: Diabetes Rates and Poverty Ratio Under 0.5 in Ohio’s Counties

Figure 22: Diabetes Rates and the Uninsured in Ohio’s Counties

Figure 23: Diabetes Rates and Number of FQHCs in Ohio’s Counties

Figure 24: Diabetes Rates and Number of Rural Health Clinics in Ohio’s Counties

Ohio Opportunity Index

The Ohio Opportunity Index (OOI) compiles over 34 variables measuring neighborhood conditions and opportunities, known to be associated with health and well-being, from a variety of domains into a single index score. This index score represents the degree of opportunity available at the Census tract level across Ohio (higher values means more opportunity) and can be used to assess overall neighborhood conditions, target interventions, and adjust evaluations for neighborhood-level risk. It can also be used to learn what types of factors are driving opportunity in specific Census tracts.

The OOI variables comprise seven key domains:

• Transportation
• Education
• Employment
• Housing
• Health
• Access
• Crime

Within each domain, several variables that met validity criteria and were available to cover the entire state at a census tract level were identified. To standardize these variables they were converted into a z-score and some z-scores were reversed in order to make positive and negative values comparable across indicators. Variable z-scores were combined using an unweighted mean and then domain scores were re-standardized to have a mean of zero and a standard deviation of one. For each domain a high score indicates a positive outcome and a low score indicates a negative outcome.

The overall Opportunity Index Score was created by using factor analysis methods to weight the contribution of each domain. Regression methods were used to validate the OOI by testing the association between the OOI domain scores and five health outcomes:

• Pre-term birth
• Child severe mental illness
• Youth asthma
• Life expectancy
• All-cause age-adjusted mortality

Ohio Children’s Opportunity Index

The Ohio Children’s Opportunity Index (OOI) compiles over 54 variables measuring neighborhood conditions and opportunities, known to be associated with health and well-being, from a variety of domains into a single index score. This index score represents the degree of opportunity available at the Census tract level across Ohio (higher value means more opportunity) and can be used to assess overall neighborhood conditions, target interventions, and adjust evaluations for neighborhood-level risk. It can also be used to learn what types of factors are driving opportunity in specific Census tracts.

The OCOI variables comprise eight key domains: access, children health, criminal justice, education, environment, family stability, housing, and infant health. Within each domain, several variables that met inclusion criteria and were available to cover the entire state at a census tract level were identified.

Construction of the OCOI consisted of the following broad steps: 1. Operationalize each measure from original, “raw” data 2. Summarize the measure for each Ohio census tract as a rate, count, or level 3. Standardize each variable, as needed, to yield consistency across measures and domains 4. Synthesize the measures in each domain to create a “domain score” 5. Create an overall Children’s Opportunity Index Score as the unweighted mean of the 8 domain scores

A time varying version of the OCOI (spanning the two periods ending in 2014 and 2017) was created that incorporates 37 of the 53 variables within the same 8 domains.

The OCOI was validated by testing the association of the OCOI and the domain scores with five health outcomes:

• Pre-term birth
• Child severe mental illness
• Youth asthma
• Life expectancy
• All-cause age-adjusted mortality

Ohio Children’s Opportunity Index by Census Tract

Ohio Chilren’s Family Stability Index by Census Tract

Ohio Infant Health Index by Census Tract

Ohio Children’s Health Index by Census Tract

Ohio Children’s Housing Index by Census Tract

Ohio Children’s Access Index by Census Tract

Ohio Children’s Education Index by Census Tract

Ohio Children’s Environment Index by Census Tract

Ohio Children’s Crime Index by Census Tract